[The causes of urodynamic disorders of the urinary tract leading to hydronephrotic transformation].

Experience had with the treatment of 372 patients, admitted to the Clinical Center of Urology--Sofia, and 16 patients--to the Clinic of Urology of the Military Medical Academy, over the period 1990 through 1992, shows that the causes leading to hydronephrotic transformation comprise diseases of congenital and acquired nature involving upper and lower urinary tracts. Congenital disorders affect men and women at an equal male-to-female ratio--1:1, while acquired ones--at 1.8:1 male-to-female ratio; causes located in both upper and lower urinary tract are recorded at a 6.

[The indications and choice for open surgical intervention in hydronephrotic transformation].

Out of the total of 372 patients treated for congenital and acquired hydronephrotic transformations over a three-year period (1990 through 1992), seventeen cases are subjected to treatment with antibiotics and antispasmodics followed by observation, and in 124 cases various types of open pyeloplastic procedures are performed. The indications for operative management of hydronephrotic transformation depends on the results of objective and laboratory studies, and subjective complaints. Accidentally discovered hydronephrotic transformations, I-II degree, may be subjected to conservative management followed by an observation period with good results.

[Drainage (prosthesis) of the pyelocaliceal system].

Of 372 patients, treated in the Clinical Center of Urology-Sofia, and sixteen patients treated in the urological clinic at the Military Medical Academy-Sofia, in 241 cases various types of polyethylene drainage systems and prostheses are used, classified into two basic groups: intraoperative prosthetic replacement, and therapeutic prosthetic replacement. Intraoperative prosthetic replacement of the pyelocaliceal system reduces intrarenal pressure, promotes uneventful operative wound healing, precludes obstruction due to the so-called sterile edema at the site of operation, and serves as a drainage and splint; nephrostoma is indicated in selected cases against the background of additional complications, whereas prosthetic replacement during endourologic manipulations is mandatory. The complications associated with prosthetic replacement of the pyelocaliceal system are rare, and lend themselves readily to nonoperative treatment, but in isolated cases surgical intervention is necessitated.

[The diseases causing stenosis and obstruction of the ureter].

A total of 681 patients with stenosis and obstruction of the ureter (SOU) have been observed over a period of 5 years. The male/female ratio was 1:1.25.

[The modern treatment of stenosis and obstruction of the ureter].

The methods used for treatment of stenosis and obstruction of the ureter (SOU) are: conservative treatment, extracorporal lithotripsy, transureteral operations, surgical management. The different genesis of the nosologic entities underlying--SOU requires adequate effective and organ preserving treatment. In the authors series of 681 patients the mot common approach to treatment und transureteral operations (46.

[The endoscopic transurethral treatment of ureterocele].

The authors describe results of transurethral endoscopic treatment of ureterocele in 61 patients, two techniques of a relevant operative intervention, indications, complications of an early (pyelonephritis) and late (vesicoureteral reflux) postoperative period, measures of their prevention. Advancing impairment of the urine outflow via the upper urinary tracts on ureterocele side necessitates earlier surgery (transurethral dissection or resection of ureterocele). Good 4-year follow-up results (normal function of the kidney, absence of pyelonephritis attacks and vesicoureteral reflux) suggest endoscopic transurethral treatment of ureterocele to be a method of choice the failure of which implies open surgical intervention.

[Intravesical distension in the corrugated tuberculotic bladder].

The treatment problem of urinary tract post-tuberculous changes is not completely solved. Current methods do not always give good results and are accompanied by some complications. The authors describe their own modified method of hydrostatic intravesical distension of the tuberculotic-cirrhotic bladder, using epidural anesthesia, and worked out indications for it.

[The surgical and spontaneous elimination of kidney calculi--the type, incidence and treatment].

Results are reported of chemical (derivatographic and polarization microscopic) analysis of 2630 calculi removed by operation and 8607 spontaneously eliminated calculi. It was found that 82.7 per cent of the calculi removed by operation and 19.

[A case of malignant intestinal lymphoma following a successful kidney transplant].

A rare case (the first one described in Bulgaria) of malignant intestinal lymphoma, developing in a 50-year-old patient 9 years after transplantation of a normally functioning corpse kidney, is reported. Basic predisposing factor for the lymphoma was the long-term maintenance immunosuppressive therapy with azathioprine and corticosteroids. Apart from this finding, a dissecting aneurysm of the abdominal aorta with partially obliterating thrombus was found.

[Cases of the regression of advanced bladder tumors (T2-T4) after the use of chemotherapy].

A. Yagoda reports that modern therapeutic schemas applied for treatment of bladder tumors have essentially increased the response rate: more than 50 per cent with full response (CRs), within the range from 28 to 40 per cent persisting for a period from 11 to more than 32 months. What appears new, noted by this author, is the complete disappearance of the tumor (restaging) following chemotherapy, demonstrated surgically and on pathologic examination.

[A case of tumors of the kidney and bladder with differing histology].

A case is presented being of interest because of the simultaneous development of two tumors at different sites of the urinary tract with different histologic structure. The patients, a 56 years old man entered the clinic on July 13, 1988 with painless hematuria. On examination, including intravenous urography, cystoscopy with transurethral echography and computer axial tomography, tumors of the right kidney and of the bladder were identified.

[A case of tertiary hyperparathyroidism following kidney transplantation complicated by lithiasis].

For the first time in Bulgaria the authors present a case of tertiary (autonomous) hyperparathyroidism, persisting in a patient who had successful kidney transplantation. Subtotal parathyroidectomy six months after the transplantation led to complete cure. Associated with the underlying disease, a rare complication was also observed in the patient--calculosis in the grafted kidney, spontaneously eliminated 40 days after the parathyroidectomy.

[The procurement and preservation of cadaveric kidneys for transplantation].

In comparison with other organ transplantations, renal transplantation has in recent years shown significant progress. It turned to be a routine and highly physiological method of treatment of patients with terminal renal failure who had been on chronic dialysis treatment. For a successful outcome of renal transplantation essential is the early and competent ascertaining that brain death of the potential donor has occurred.

[The M-VEC chemotherapy of advanced bladder tumors].

The authors have treated 34 patients (32 men and 2 women) with advanced transient-cell bladder tumors. Depending on the degree of their infiltration, the tumors were divided in two groups: I. Locally advanced resectable tumors T2-T3B--25 patients, in 16 of whom TUR and in 9 open operation was performed; II.

[The surgical treatment of urogenital fistulae of obstetrico-gynecologic origin].

Ninety-two patients with urogenital fistulas of obstetric-gynecological origin have been treated at the Department of Urology of the Medical Academy in Sofia for a period of 14 1/2 years. Eighty seven women (94.6 per cent) were operated, with a total of 97 operations being performed.

[The clinical course and diagnosis of urogenital fistulae of obstetrico-gynecologic origin].

Ninety two women with urogenital fistulas of obstetric-gynecological origin comprise the study group. In 23 patients (25 per cent) urine outflow from the vagina started immediately after the operation and in 69 (75 per cent) from the 3. day to 2.

[Immunotherapy with Solco Urovac vaccine in chronic genitourinary infection].

Twenty five patients with chronic urogenital infections (cystitis, pyelitis and prostatitis) were treated with Solco urovak infection which is active against Escherichia coli, Proteus, Klebsiella and Streptococcus fecalis organisms. This microbial flora has been isolated from these patients and proved resistant to the conventional antibacterial agents. The vaccine was very well tolerated, gave no side reactions, but transient short lasting rise of the temperature to 38 degrees C.